2025 ICD-10-CM code H54
(Active) Effective Date: N/A Revision Date: N/A Diseases of the eye and adnexa - Visual disturbances and blindness 7 Feed
Blindness and low vision.For a definition of visual impairment categories, see the table below. Code first any associated underlying cause of the blindness.
Medical necessity is established by the presence of visual impairment impacting the patient's daily life or posing a risk to their health and safety.The specific level of impairment should be documented to justify the medical necessity of interventions or supportive services.
The clinician is responsible for documenting the patient’s visual acuity and visual field measurements for both eyes. This information, along with the WHO categories for visual impairment, should be used to select the appropriate H54 code.Any underlying condition causing the blindness should be coded first.
In simple words: This code represents vision problems ranging from low vision to complete blindness in one or both eyes.
Blindness and low vision. The code H54 is used to report various levels of vision impairment, including low vision and blindness, impacting one or both eyes. The World Health Organization (WHO) has defined categories for visual impairment, which range from mild to blindness based on visual acuity and visual field. These categories should be used to determine the appropriate H54 code.
Example 1: A patient presents with a visual acuity of 20/200 in the right eye and 20/400 in the left eye. This would be categorized as severe visual impairment and coded as H54.2., A patient has complete blindness in both eyes due to diabetic retinopathy. Diabetic retinopathy (E11.36) would be coded first, followed by H54.0 for blindness in both eyes., A patient has a visual acuity of 20/70 in the right eye and 20/40 in the left eye. Since the better eye has a visual acuity better than 20/70, this would be classified as mild or no visual impairment.
Documentation should include visual acuity measurements and visual field assessments for both eyes. The specific WHO category of visual impairment must also be documented. If there is an underlying cause for the vision impairment, this should also be clearly documented.
** Excludes1: amaurosis fugax (G45.3).Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth, and the puerperium (O00-O9A), congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99), diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-), endocrine, nutritional and metabolic diseases (E00-E88), injury (trauma) of eye and orbit (S05.-), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94), syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71).
- Payment Status: Active
- Specialties:Ophthalmology, Optometry
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital